Dispatches from the 10th Crusade

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"I hope I die before I get old."

People try to put us d-down (talkin bout my generation)
People try to put us d-down (talkin bout my generation)
Just because we g-g-get around (talkin bout my generation)
Just because we g-g-get around (talkin bout my generation)
Things they do look awful c-c-cold (talkin bout my generation)
Things they do look awful c-c-cold (talkin bout my generation)
Yeah, I hope I die before I get old (talkin bout my generation)
Yeah, I hope I die before I get old (talkin bout my generation)

So true. I've thought of it many times in many contexts. Infanticide being another example. When the Groningen Protocol came out, one of the doctors who was fine with it had the gall to say (calling back up from the bottom of the moral cliff), "This is not the slippery slope." I couldn't help wondering where else he thought there was to slip at that point. Killing healthy newborns, I guess.

Jack Kevorkian, hero for a new generation. Jack's only two mistakes were, he was ahead of his time, and much worse, he intruded on government territory.
Well if Abdel al-Megrahi can be freed are we less charitable then the Brits? Is not a rehabilitation in order? A statue in whatever new monstrosity of a federal building is constructed for the ghouls soon to be put on the federal gravy train? An oil painting in the office of Eziekiel Emanuel?

Among other things you may expect to see a broadening of what could be called the Terri Schiavo option. And we conservatives were so intrusive and obnoxious back then, naughty us.

We could start, Clayton, by not considering suicide drugs ("physician aid in dying," as the letter has it) to be a form of medical care. That way there wouldn't be, you know, this financial competition between an expensive chemo drug on the one hand and a relatively inexpensive "aid-in-dying" prescription on the other. I'll wager there would not even have been a news story if it weren't for the physician aid in dying angle in Oregon. Look for stories like this to begin coming out of other states (WA just legalized suicide not long ago) as well.

"We could start, Clayton, by not considering suicide drugs ... to be a form of medical care."

Is the issue that she's not received support for chemo or that she's being offered support for suicide drugs? I take it that the position that FB supports is that it's best if she's given neither unless she can afford the insurance that would cover her chemo.

Is that your position or are you on board for unlimited socialized medicine?

Perhaps we should take better care of our old folks simply because of the debt we owe them for bringing us into existence, of loving,caring and teaching us? or because they like us are made in the image and likeness of God ..............Sorry for being so sentimental I forgot that modern materialist man knows nothing of care, compassion ect ect

Do you think that this doesn't happen to people with private insurance or people without insurance?

False dilemma. Who said I am a fan of the current state of private insurance?

Years ago CATO Institute published a book called Patient Power. I would say that my view is along the lines of the proposal suggested in that tome.

Moreover, it's not "what happens" that should be the exclusive focus of our reflection. it should be "what the state does." Private insurers do not have absolute police powers The state does. And it is the state that acts. The passive voice diminishes the significance of "the happening."

In addition, properly assessing "what happens" cannot be isolated from the actors and their political powers. Suppose, for example, Mr. Jones tortures Mr. Smith in the privacy of his own home because he just likes to torture. That is, of course, immoral and sick. But suppose that Mr. Jones works for the CIA and tortures Mr. Smith as part of his routine job performance. Now, would it make any sense if I responded to those who objected to the latter by saying, "Do you think that this doesn't happen to people in private?"

Is the issue that she's not received support for chemo or that she's being offered support for suicide drugs?

You can't get that it's the combination, and being offered, too, by the State of Oregon, that rather makes it look like Oregon is in the death business and prefers death as cheaper than treatment? I mean, come on. Most liberals are always talking about "context." The denial of the chemo in the context of offering death is what is intensely creepy. Suppose a charity existed to help the poor. It might be a little odd if they didn't pay for baby formula, but, hey, there might be a lot of reasons--maybe the founder of the charity was a breast-feeding fanatic. But if they don't pay for baby formula and do pay for abortion, _that's_ bad news.

The fellow being interviewed is flat-out lying. He says "we don't think about investing our health care dollars in that way," then turns around and says that paying for the lady's chemo takes dollars away from someone else.

"I take it that the position that FB supports is that it's best if she's given neither unless she can afford the insurance that would cover her chemo."

"The denial of the chemo in the context of offering death is what is intensely creepy."

I'll grant you that. However, denials of coverage are inevitable in any system that won't cover those who can't afford to cover themselves. So, unless we don't offer people assistance for suicide, people will continue to find themselves in a situations that are as bad or worse than the situation that this woman in Oregon faces. (If you asked people, say in Oregon, whether they'd rather receive limited coverage and no coverage for suicide drugs or limited coverage with coverage for suicide drugs, my guess is that they'd opt for the second option. I think some empirical research suggests that this is so.)

I don't know what FB's position is, but I doubt that the folks at the Cato institute have found a policy on which everyone is fully covered. If they've somehow managed to hit upon a plan according to which everyone received limitless coverage, that's fantastic! Let's make that happen!

Until the Cato institute's perpetual motion machine gets cranking, people will either be denied coverage by private insurers or will receive limited coverage from public and private entities. I doubt that FB's position is that the government should coerce those of us who are healthy and can afford insurance to subsidize those who cannot. So, I doubt that FB is offering us an alternative to a system where people like this poor woman are denied coverage.

What's really, exceedingly creepy is that no doubt he doesn't _think_ he's lying. I swear, it's like you put these things in place, and then these people start acting like little machines, or cogs therein. Here you have a set-up composed of several different components, including, most strikingly, the fact that PAS is legal in Oregon, is regarded as medical care, and that nobody even passed a law prohibiting state funds to be used to pay for it. _So_, Oregon then sets up a mini-socialized medical plan for its own state poor and sets up a board to determine who shall get this or that treatment, based in part on costs. Straight centralized medicine, takes it as far as possible away from the market, tries to control costs and over-demand by central planning. This sort of thing is foolish economically, but it's the way liberals think things get done "rationally." This guy gets put in charge of the panel. From there on, he tries to act like a computer that is part of the system. Looks at that chemo drug--$X in expense for X probability of X months of life--nyet. But then they are supposed to list all the things they _can_ offer to pay for. (We want to tell the lady the good news and what her benefits are, right?) Looks at PAS--legal, counted as medical care, no block on state funds, inexpensive, it gets the thumbs up and gets put on the list, along with hospice and palliative care. And the deed is done. The reporter asks him if the idea is that it was cheaper to pay for her to die than for her treatment, and he says no, that's not how they think, that isn't the idea. And he thinks he's telling the truth, because they more or less mechanically cranked out this infernal list without, probably, consciously saying to themselves, "Oh, gee, look what this means. We're willing to pay to kill this woman but not to treat her. That's not so good."

And that's what you get once these factors are put in place. Which is truly frightening.

If you asked people, say in Oregon, whether they'd rather receive limited coverage and no coverage for suicide drugs or limited coverage with coverage for suicide drugs, my guess is that they'd opt for the second option. I think some empirical research suggests that this is so.

Since it's evil to offer people suicide drugs, and since it's even worse for the state to be doing it and thus coercing material cooperation from all state tax-payers, plus making poor people like this woman feel like Big Brother wants to help them die, I don't give a tinker's damn if this is true, though I suspect it isn't. I'm sure the Hemlock Society would be happy to help all those eager beavers who want to bump themselves off, and the state could stay out of the killing business.

Although I can't watch the video (dialup, at home), I think I get the gist of it. This topic is one that I have had to stay away from addressing because my anger approaches the level of sin. If anyone ever wanted evidence that God is mis-understood in this country, the growing support for PAS is it. Mis-understood is the nicest word I can use. Sinful, pridefully hubristic, narcissistically delusional of godhood, or just plain hypocritical is what I would rather use to describe the moral reasoning of the people who promote PAS. Oh, people believe in God, is that it? Ninety percent of people in the United States believe in God? These sorts of people render the very word meaningless or worse, a lie.

It says in one of the psalms, that if your father's mind fails, grieve him not in your strength. These people should get on their hands and knees and thank God that their parents give them the gift of life. What do they offer in return - the gift of death. Hypocrites, hypocrites, all.

I'll stop, now, before I wander too far into the land of anger and passion and sin.

"Denials of coverage are inevitable in any system that won't cover those who can't afford to cover themselves."

That's true of life. Every child born eventually dies, or "runs out of biological resources."

Just because no system can cover everybody, does not justify any arrangement in which not everybody is covered. Suppose, for example, HR 3200 becomes law and in 20 years, as predicted, there is only the public option/single-payer plan. It results in fewer doctors (as predicted), fewer resources, longer lines, etc. In that scenario there is a distribution of resources and goods as there will always be. But is it better, since in this hypothetical scenario everyone is being treated "equally," equally bad? If, for example, I could have lived longer if the public option didn't exist, should my estate be allowed to sue the government for wrongful death because it was clearly foreseeable that that the state of affairs would result? But the government, unlike private insurers and physicians, is protected by sovereign immunity. And, if upon seeing this, my neighbors want to go elsewhere for their medicine, where do they go?

If you compare every scenario against utopia, we all wind up dead. But the appropriate comparison is between private providers and the government. And with that comparison, the jury's verdict is in: private providers do not provide for everybody, but they have far more incentives to produce better medicine, better bed-side manners, and greater choice than any government option. Thus, in the long run, everyone is better off with private medicine. If one knows that it is available if one makes the right career and personal choices, then that provides citizens with an understanding of its value and importance. But if you know you're gonna get sub-par care no matter what you do, then why care?

Does the health care system need reformation? Of course. But what is needed is creative ideas about how to channel free-market forces while at the same time caring for our most vulnerable citizens. The CATO plan is a reasonable one in that regard. Others, such as Senator DeMint, have offered others. But turning all medicine into medicare and medicade is like turning homeschooling into public schooling. Why would anyone want to kill excellence just because not everyone can get it? Envy is a vice. It's not a public policy.

It's interesting how this local news video (from my local ABC affiliate here in Portland, OR) has been making the rounds lately. I've posted the following at MCJ, but I'll repost my comments here:

- In case you didn’t catch it, this story is from 2008, approx. 18 months ago. ABC Nightly News did a 90-second spot on it at the time and the local newspaper in the Salem area ran a story, but _no other national news media outlet ran anything on it_. Not one.
- It highlights the problems with: a) rationing and b) the basis on which care is rationed. With rationing, some people die for lack of care; it’s that simple. Some argue that health care is currently rationed by ability to pay (i.e. whether or not you have insurance); that may be true, but in that case, when you come across someone like this lady who needs treatment they can’t afford, charity efforts (in this case, the drug company - or family and friends having a fundraiser, collecting donations at the bank, etc.) can be implemented to fill the gap.

In this case, care is rationed deliberately according to a cost-effectiveness model. Others have noted above that the OHP representative refused to answer the question of whether it’s cheaper to help someone live than help someone die, saying “We don’t think about that question.” Of course they don't; it would be unpleasant and bad marketing to acknowledge the facts of where deliberate, no-other-options rationing leads. Nothing to see here, move along.

Also, the cancer doctor’s point is very, very important: The OHP was looking at statistical models from 1993 to make their determinations. Human beings and the way their individual bodies work do not always conform to statistical models, especially outdated ones. OHP says, “It won’t work for everybody”; the doctor says, “It might work for her”. These are precisely the sorts of decisions that are currently made by doctors and patients, and will be made by bureaucrats and beancounters (who don't have the doctor's perspective) if we get nationalized health care.

Let me add that if Clayton were to ask me, an Oregonian, whether I'd "rather receive limited coverage and no coverage for suicide drugs or limited coverage with coverage for suicide drugs", I would most emphatically reply NO, THANK YOU to coverage for assisted suicide. That's like asking a sick, depressed person going through the health-care drive-through: "Do you want a loaded gun with that?"

I'm currently involved in helping a chronically ill family member who's on Medicare and Medicaid/OHP. We fight every day to find him proper residential care while taking care of him ourselves, and we strive to make sure he knows he's valued and loved. Letters from the state offering assisted suicide do not help us in our task.

All of this is not to say I’m against health care reform. I just think that with the current entrenchment of the culture of death, the Dems’ current proposals won’t create a more just result. A different subset of people will die; that’s the only difference.

I agree with Lydia and William that the state should not be subsidizing PAS. It can be legal without being state funded, and it surprised me that anyone in any government capacity imagined this would be something less than a disaster.

Private insurers do not have absolute police powers The state does. And it is the state that acts.

The state of Oregon did not use its absolute police powers to prevent her from getting the chemo drug on her own (which is what she did), or stop her church or other community groups from holding charity collections, etc.

We want to tell the lady the good news and what her benefits are, right?

I would like to know if her doctor suggested any less expensive treatments before trying to get her onto this particular one. This drug is most often used as the secondary treatment after the first round of chemo has failed for lung cancer, but it can also be used as the first treatment for pancreatic cancer. So her odds are pretty grim just from that, and this drug is highly targeted in how it benefits the patient. According to the clinical trials, the average patient increases their average survival time by two months (4.7 months to 6.7 months). If the tumor is of a certain type, or the patient has never smoked, or the patient is Asian(!), all can increase the effectiveness of the drug. For $90 per pill, taken one each day, the average result is significant but the cards are still massively stacked against the patient. Of course, everyone hopes they are going to beat the odds.

now for something completely out of subject: A question for Dr Beckwith. In Defending Life, you claim that all abortions are killing of the unborn...however Boonin and Walter Block have both tried to argue (not very convincingly, though one has to admire the casuistic effort) that some abortions are only cases of evictions followed by "letting die"....what is your response to such a charge?
( personally I don't think that the argument holds water since by Philipa Foot's definition of causation, A has caused B's death if, by acting in a particular way, A has put B in a situation of mortal danger in which B was not before. Thus A still kills B. Now the opponents of such a theory of causation may appeal to preexisting conditions but that line of thinking has its own limitation : while its true that the woman in Thompson's argument might not be causing the death of the violinist since the violinist infact succumbs to an ailment that existed before him being connected that is not the case in other situations. Hence, if you throw an unauthorised passenger off your plane at an altitude of 10 000m without a parachute, the preexisting condition that the passenger can't fly is laughable since it is an unjust and unreal expectation. )....

And all along I thought it was only the morally flawed, those burdened with the sin of avarice that held the purse above their fellow man.
One would think that if you must ration a set of services heretofore not rationed, and with no immediate need for rationing in their present environment, modesty might inspire you to look elsewhere to ply your reformist impulses.

In one of the Federalist Papers it's offered as a benefit of a federalist system of government that the States may experiment as they wish, but let the "contagion", as it's called, be restricted to the state.
Too bad the crowd in Washington has other agendas and can't be bothered with such piffle.

johnt, both the states and national Big Brother have lost the sight of the original federalism, the vision that we won't have a "national" system, but rather that each individual state as a state is a party to the larger union and is a party to the consent by which the federal government acts. Now, the "federal" government acts on anything it decides is of national significance, whether the Constitution says it has the power or not.

Tony, noted and agreed to, emphatically.
You have put in the first sentence the heart of the Founding. Not quite as good as Calhoun, but pretty damn good.
The rest touches upon what used to be called lawlessness.

One would think that if you must ration a set of services heretofore not rationed, and with no immediate need for rationing in their present environment, modesty might inspire you to look elsewhere to ply your reformist impulses.

Last time I checked, slightly more than 60% of the federal stimulus money being sent to the states was instead used to cover their costs on Medicaid. So the present environment is, excuse the pun, on life support.

And all along I thought it was only the morally flawed, those burdened with the sin of avarice that held the purse above their fellow man.

That compassionate side reappears at the strangest times. Even Douthat has pointed out the strategic incoherence of winning this particular battle with this tactic.

Maybe Republicans will be able to cast themselves as the protectors of entitlements today, and then impose their own even more sweeping reforms tomorrow. That’s the playbook that McConnell, Brownback and others seem to have in mind: first, save Medicare from Obama; then, save Medicare from itself.

Does the health care system need reformation? Of course. But what is needed is creative ideas about how to channel free-market forces while at the same time caring for our most vulnerable citizens.

First, "free-market forces" alone are far from sufficient, or all we'll have is end-of-life rationing for everyone but the very affluent. A completely different anthropology is required, and if Christians try to make the argument that an amoral, neutral Market is preferable to an immoral Leviathan, they are conceding the outcome in advance.

Step2, I hope you don't mind if I keep this short. You do know I am capable of more but sometimes the endurance fails. Maybe, probably, tomorrow, but for now a short one.

First, and out of courtesy, thanks for Ross Douthat but who the hell cares and why? And what in the absence of detail is meant by "save"? It's OK, don't give me the whole column.

Thanks for reminding me what I wrote but your first para; please, as an act of mercy can you refrain from the excruciating trope "the last time I checked"? Clinton, zipper up or down, used to use that.
More important, in your passion to enlighten me with the rays of collectivist thuggery, why would you super impose Medicaid over the entire American health care system? It is the entire system at stake, my subject, not the flop of Medicaid.
And do you not see the gross error of using failure as an excuse to extend control over the less controlled?
"life support", and you want more of it???

"Compassion", you brought it up, I didn't. It makes me nauseous. the same sickening implications as "altruism". I must stop, I haven't eaten yet and don't remind me of George Bush !

I'm sure I've missed a few things but sadly tomorrow is another day.
Step2, you do seem like a nice guy, go easy on my heart. Thanks

Kevin, I think part of the problem is that few people actually detail what a free market reform would look like. The example you cite points directly to the most commonly advocated free market reform of all, which is the federal government striking down state-initiated regulatory barriers that prevent insurance companies from being able to sell policies across state lines. The limited access you're describing is not a function of fee market forces, but of overbearing local regulatory systems that constrain the level of competition and force people into a system where "choice" is just a word rather than a practical reality. There's a reason that Arby's can sell you a sandwich anywhere, but a person living in Santa Monica can't buy an insurance policy written in New Haven. Reforming that system would cost not one red cent, and would alleviate one of the principal barriers to effective competition and the efficiencies that are unique to a robust market system.

Sage, I am open to any suggestions that create genuinely free and ethical markets and yours seems to make sense.

However there is so much that needs to be addressed. For instance, reimbursement policies reward physicians and institutions that use imaging technology and certain surgeries, yet are punitive towards those physicians relying on human judgment and discernment. A primary care doctor who arrives at a diagnosis based on a patients reported symptoms, family history and the doctor's own training and insight, will under a best case scenario, receive endless push-back before receiving a reduced reimbursement. Not so in the case of MRI's or nuclear stress tests. Which is why it is the imaging center within any medical group or hospital that is the most profitable.

Interesting how this modern bias for the purely rationale and mechanical consistently trumps the role of the human actor, and how it always winds up costing us in so many ways.

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